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OBA (! ,� FACILITY <br /> ADDRESS <br /> MAILING ADDRE S" <br /> 1. Operating Permit A <br /> pplication/Annual Inspection Fee <br /> a. First Tank at Facilitv @ $150. <br /> b. Additional Tanks (N Additional Tanks x $50) <br /> 2. State Surcharge (per tank <br /> (Due with Permit Application, <br /> on renewal or amendment of operation permit and temporary closure) <br /> (856 x Total N Tanks) <br /> 3. 'Temporary Closure <br /> (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> y *(N_ Temporary closures x $80) (See above N3 to calculate surcharge) <br /> 4• Permanent Closure (per tank) Underground Storage Tank in which <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank , <br /> (N Permanent Closures x $90) PAYMENT / G es, <br /> 5. Plan Check Fee $30. <br /> RECEIVED <br /> NOV 7 1988 <br /> 1 Total Number of Tanks / INARONMEE��Tt�t �I �j ` <br /> 11T/S�RF 'EOue �c <br /> Make all fees payable to San Joaquin Local Health District Enclose this worksheet <br /> with your check <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> ( 1 regular, 1 unleaded, I supreme, 1 waste oil ) <br /> Ia. Existing Facility & Ist Tank <br /> $150 <br /> b. 3 Additional Tanks x $50 <br /> 2. State Surcharge, 4 Tanks x $56 150 <br /> 224 <br /> Total Number of Tanks 4 <br /> — Total Fee Due $524 <br /> 'Both closures will be conditioned. Contact a Health District Representative. <br /> 2-86 <br /> UST al <br />